ACS - Risk Stratification

Likelihood Sx d/t CAD

History-chest or L arm pain or discomfort as chief symptom reproducing prior documented angina, known history of CAD, including MI

Exam-transient MR, hypotension, diaphoresis, pulmonary edema or rales

EKG-new or presumably new, transient ST segment deviation > 0.05mV or T wave inversion > 0.2mV with symptoms

Markers-Elevated cardiac troponin I troponin T or CK-MB

Any of the below-none of the above:

History-chest or L arm pain as chief symptom, age > 70, male, diabetes

Exam-extracardiac vascular disease

EKG-fixed Q's, abnormal ST segments or T waves not documented to be new

Markers-normal

None of above but may have:

History- recent ischemic symptoms without any interm. or high risk features. Recent cocaine use

Exam- reproducible chest discomfort on palpation.

EKG- T wave flattening or inversions in leads with dominant R waves. Normal EKG

Markers-normal

Risk of Death or MI in pts with UA=== ===

At least one feature:

History- accel tempo of ischemic symptoms in preceding 48 hrs

Character- prolonged (greater 20 min) rest pain

Clinical findings-pulm edema -most likely related to ischemia

-New or worsening MR murmur

-S3 or new or worsening rales

-Hypotension,bradycardia, tachycardia

-Age greater 75

ECG- angina at rest with transient ST changes greater than .05 mv

-Bundle branch new or presumed new

-Sustained V-tach

Markers-markedly elevated (tnT or TnI ) 0.4ng/ml

No high risk features, at least one of the following:

History-prior MI, peripheral or cerebral vascular disease, prior CABG, prior ASA use

Character-prolonged (greater than 20 min) rest angina...now resolved, with moderate or high prob of CAD

-Rest angina (less than 20 min. Or relieved with rest or NTG

Clinical findings-Age greater 70

ECG findings-T wave inversions greater than 0.2Mv, pathological Q's

Markers-slightly elevated (tnt greater than 0.04 but less than 0.4 ng/ml

No high risk or intermediate risk features but may have:

History-New onset CCS class3 or 4 angina in the past 2 wks with mod or high likelihood of CAD

ECG-normal or unchanged ECG during episode of chest discomfort

Markers-normal

Authors: